Post-COVID Transplants, Long COVID Impacts with Kenneth McCurry, MD & Maryam Valapour, MD, MPP

During the latest episode of Lungcast, 2 Cleveland Clinic lung transplant experts joined host Albert Rizzo, MD, American Lung Association (ALA) chief medical officer, to hold an important conversation on optimization of the system of lung allocation in reducing waitlist times and patient death rates.

Rizzo’s guests, Maryam Valapour, MD, MPP, and Kenneth McCurry, MD, from the Cleveland Clinic Lung Transplant Team had spoken on the notable changes that lung allocation has undergone in the past 2 decades. In another segment of their interview, McCurry and Valapour discussed post-infectious COVID-19 patients’ eligibility for lung transplants.

“I will tell you that in 2021, immediately after the pandemic, the 2 new categories of diagnoses became prevalent as indications for transplant,” Valapour explained. “So 1 was COVID (Acute Respiratory Distress Syndrome) and the second was interstitial lung disease due to COVID. In 2021, 1 out of every 10 lung transplants were performed nationally as a result of the complications from COVID. Those numbers have come down now, but that was kind of the impact of the pandemic on the system.”

Valapour added that the total number of transplants went down during the pandemic, noting that clinicians are beginning to go back to pre-pandemic numbers.
“At the clinic, we struggled during the pandemic, as most large lung transplant programs did on how to approach this and how to deal with this,” McCurry added. “So prior to the pandemic, essentially all lung transplant programs would decline any patient for transplant who was in acute respiratory failure from ARDS or some sort of other etiology. As we've discussed, long term outcomes are still plagued by issues. Organ access is still difficult and plagued and we have more need than at least current utilization is, although many of us are working on ways of increasing the supply.”

McCurry noted that at the time, the Clinic had seen patients who were acutely ill and ventilated as being too risky to consider proceeding with a lung transplant. He explained that this would change with the pandemic.

“We, like many other lung transplant programs, struggled initially with how to approach this,” Mccurry said. “Do we accept these patients? Do we not? If we do accept them, should we hold onto the same criteria that we hold ambulatory patients to?...For our hospitalized patients who are quite sick in general, our approach for a decade or more has been to try to ambulate them either on positive pressure ventilation or with ECMO support, so that they're not deconditioned and those sorts of things.”

Rizzo later inquired as to if there had been any literature related to post-COVID transplant patients developing or having had long COVID, potentially impacting their rehabilitation.

“So I will say that there is not much literature yet,” Valapour said. “The pandemic occurred in 2020 and very quickly after that, we did include these diagnoses in the transplant registries to start capturing the experience. I will say it will probably be years before we know what the long term outcomes of this patient population is, but at least we started capturing it within months of the onset of the pandemic.”

Lungcast is a monthly respiratory health podcast series from the ALA produced by HCPLive.

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